World Bank report says TB control would lead to massive economic gain
for poor countries

12 December 2007

A new World Bank research report finds that 22
countries with the world’s highest numbers of TB cases could earn
significantly more than they spend on TB diagnosis and treatment if they
implemented a global plan to sharply reduce the numbers of TB-related
deaths. Highly affected African countries could gain up to 9 times their
investments in TB control.

The study also warns about the need to step-up TB control worldwide with
the growing emergence of multidrug-resistant TB (MDR-TB) and extensively
drug-resistant TB (XDR-TB) in Southern Africa, Eastern Europe and Central
Asia.

The report says that despite recent gains in fighting TB, there were
still 8.8 million new cases and 1.6 million deaths from the disease in 2005.
Without treatment, two-thirds of smear-positive cases die within five to
eight years, with most dying within 18 months of being infected.

According
to the study, The Economic Benefit of Global Investments in Tuberculosis
Control(1), the economic impact of TB deaths and the benefits of TB
control among the 22 high-burden countries(2) are greatest in China and
India, where the combination of growing incomes and a relatively high number
of TB deaths translates into a significant economic effect.

The study,
which was commissioned by the World Bank on behalf of the Stop TB
Partnership and funded by the Bill and Melinda Gates Foundation, has
attracted considerable interest from international health and development
agencies, along with research and civil society groups, which want more
aggressive TB control worldwide. The disease is the leading infectious
killer of adults after HIV/AIDS.

“This report set out to test whether the economic benefits of TB control
are greater than the costs. It turns out that likely benefits are of
impressive magnitude,” said Dr. Jorge Sampaio, the UN Secretary-General’s
Special Envoy to Stop TB, and former President of Portugal.

What the
study means for Africa

The study estimates that the economic cost of
TB-related deaths (including HIV co-infection) in Sub-Saharan Africa for the
ten years from 2006-2015 will be US $519 billion when there is no effective
TB treatment as prescribed by WHO's Stop TB Strategy.

However, if these same countries in Sub-Saharan Africa were to offer such
treatment to TB patients, in keeping with a global plan to halve the
prevalence and death rates by 2015 relative to 1990 figures, countries could
see their economic benefits exceed their costs by about 9 times over. The
Global Plan to Stop TB, devised by the Stop TB Partnership (3), would cost
US$2 billion a year for TB diagnosis and treatment until 2015 in Africa, and
US$ 5-6 billion worldwide.

"There were already compelling reasons to fight
TB, which causes massive human suffering. Now, as a further incentive, there
are strong indications that investment in meeting the Millennium Development
Goal related to TB carries important economic benefits,” says Dr. Margaret
Chan, Director-General of the World Health Organization (WHO).

Stepping up
TB treatment also makes economic sense outside Africa. The study finds that
the economic return would be even higher in countries such as China and
India, where income-growth projections over the next 10 years are higher and
the burden of HIV co-infection lower.

TB worsens poverty

The new study says that by sickening or killing working-age adults, TB
imposes a heavy cost on people’s incomes as well as national economies. For
example, in Zambia, adult deaths among small maize and cotton farmers caused
crop yields to fall by roughly 15%. Children are vulnerable to TB as well,
and the disease may force them out of school, limiting their future job
prospects.

“This important new study shows us why TB control is a smart investment
in lasting development for low-and middle-income countries” says Joy
Phumaphi, World Bank Vice-President for Human Development, a former WHO
Assistant Director General and former Health Minister in Botswana.

“This economic justification for TB control strengthens the case for
governments and donors to sharply reduce TB prevalence and deaths in the
name of better health and higher incomes for people living at grave risk of
TB illness and death.”

Phumaphi says the World Bank will intensify its support for TB control,
while continuing to work with countries in Eastern Europe, Central Asia and
South Asia. In Africa, she says, the Bank will take a more proactive
approach to financing country-led efforts, using existing channels,
sector-wide programs, combined HIV and TB control programs, and
multi-sectoral operations.

Call for accelerated action

The study calls for urgently
accelerated global TB control because of multiple factors:

the extraordinary burden of TB on those afflicted by the disease,
their families, and on government budgets;

the dramatic growth of TB cases over more than a decade in Eastern
Europe and Central Asia; and

TB patients in Eastern Europe and Central Asia are 10 times more
likely to have MDR-TB than in other regions of the world, and up to 15%
of new cases are multi-drug resistant. The report says the threat of
MDR-TB underscores the urgency for all TB-affected countries and health
and development agencies to push for the fullest-possible adoption of
The Global Plan to Stop TB; the Plan calls for a shared investment by
countries heavily affected by TB and donors.

"This report should wake
up countries to the urgent need for a stronger financial commitment to TB
control," says Michel Kazatchkine, Executive Director of the Global Fund to
Fight AIDS, Tuberculosis and Malaria. "Effective TB control has a positive
impact on the lives of the millions of people infected with TB, on whole
communities and it reduces the burden of disease on national economies."

3. The Global Plan to Stop
TB, launched by the Stop TB Partnership (www.stoptb.org
) in January 2006, sets forth a roadmap for treating 50 million people for
TB and enrolling 3 million patients who have both TB and human
immunodeficiency infection on antiretroviral therapy over the next 10 years,
saving about 14 million lives. It aims to halve TB prevalence and deaths
compared with 1990 levels by 2015.